Diyaliz ilişkili amiloidozisin high flux ve standart hemodiyaliz tedavisinde radyolojik ve sintigrafik bulguları

Amaç: Uzun süredir hemodiyaliz (HD) tedavisi alan hastalarda gelişen diyaliz ilişkili amiloidozisin (DİA) radyolojik ve sintigrafik bulgularının High flux (HF) ve standart (STD) HD tedavi gruplarında değerlendirilmesi. Yöntem: En az 3 yıldır diyaliz uygulanan 16 standart HD ve 16 HF HD hastası çalışmaya alındı. Hastalarda her iki omuz ultrasonografi ile incelendi. Supraspinatus tendonunun maksimum kalınlığı ve biseps tendonunun transvers çapı ölçüldü. Rotator kılıf tendonları ve biseps tendonunun ekojenitesi, fibriller yapısı; tendon yırtıkları; biseps tendon kılıfı ve subakromial-subdeltoid bursada hipoekoik materyal birikimi, sıvı varlığı; hiperekoik polipoid sinovyal kalınlaşma araştırıldı. Hastalara diyaliz öncesi 20 mCi Tc-99m MDP (metilen difosfat) ile kemik sintigrafisi çekildi. Bulgular: STD HD alan hastaların % 68.75’inde, HF HD tedavisi alan hastaların % 50’sinde amiloidin omuz ultrasonografi bulguları saptandı. STD HD grubunda DİA daha yüksek oranda görülmesine rağmen gruplar arasında istatistiksel fark saptanmadı (P=0.280). Sintigrafik değerlendirmede, standart HD tedavisi alan olguların % 75’inde, HF HD tedavisi alan olguların % 81’inde radyoaktivite tutulumları saptandı. İki grup arasında sintigrafi bulgularında da istatistiksel fark saptanmadı (P= 0,394). Sonuç: Omuz USG’si DİA tanısında etkili bir radyolojik araçtır. Standart ve high-flux hemodiyaliz yapılan hastalarda diyaliz ilişkili amiloidoz benzer oranlarda saptanmıştır.

Radiological and scintigraphic findings of amyloidosis related with dialysis in treatment of high flux and standard hemodialysis

Objective: This study was undertaken to evaluate the radiological and scintigraphic findings of amyloidosis related with dialysis after treatment of high flux (HF) and standard (STD) hemodialysis (HD). Methods: This study included a total of 16 standard HD and 16 HF HD patients who were treated with dialysis for at least 3 years. Both shoulders were assessed by ultrsonography (USG). Maximal thickness of the supraspinatus tendon and transverse diameter of the biceps tendon were measured. Fibrillary structure and echogenity of the rotatory sheat and biceps tendons; tendon tears; accumulation of hypoechoic materials and fluid presence at the biceps tendon sheat and subacromial-subdeltoid bursa; hyperechoic polypoid sinovial thickening were investigated. Bone scintigraphy with 20 mCi Tc-99m MDP (methylene diphosphonate) were performed in the patients before dialysis. Results: The shoulder USG findings of amyloidosis was detected in 68.75% of the patients treated with STD HD, and in 50% of the cases applied HF HD treatment. Although DİA was found higher in STD HD group, no statistical significant difference was obtained between two groups (P=0.280). Radioactivity involvement was detected in 75% of standard HD patients, and 81% of HF HD patients. There was no difference in scintigraphic findings between two groups (P= 0,394). Conclusion: Shoulder USG is an effective radiologic tool in the diagnosis of DİA. Amyloidosis related with dialysis was found similar ratio in the patients undergoing high flux and standard hemodialysis.

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